medwireNews: Antibiotic prophylaxis can help reduce the risk for urinary tract infection (UTI) after the removal of a urinary catheter, suggest findings from the first meta-analysis of study results.

But the authors caution that unless individual risk factors can be identified and taken into account, then the benefits of antibiotic prophylaxis may be mitigated by factors such as increased costs, antimicrobial resistance, and side effects.

"From a public health standpoint, we should be careful not to encourage antibiotic use when it might not be necessary," comment Jonas Marschall (Washington University, St Louis, Missouri) and colleagues.

Nevertheless, they found that there were significantly fewer symptomatic UTIs within 2 weeks of urinary catheter removal in patients who received prophylaxis than in those who did not receive prophylaxis, at 4.7% versus 10.5%.

The authors calculate that the use of antibiotic prophylaxis was associated with a 55% lower risk for UTI compared with controls and that the number needed to treat to prevent one symptomatic UTI was 17.

The meta-analysis included five published randomized trials, one unpublished randomized trial, and one non-randomized, controlled study, involving a total of 1520 patients undergoing prostatectomy, general surgery, or staying on medical or surgical wards.

Marschall and colleagues say that while their results point to an overall benefit of antibiotic prophylaxis, the issue raises several important considerations.

"Antibiotic prophylaxis at the time of catheter removal could lead to a dramatic increase in consumption of antibiotics in hospital, based on the assumption that at least 20% of patients are catheterized at some point during their hospital stay," they note, writing in the BMJ.

And, while routine screening for bacteriuria would be prohibitively costly, they conclude that future studies should identify patients who are most at risk for the development of UTIs, and could therefore be targeted for prophylaxis.